Treating depression - the cognitive approach

• Beck: patient and therapist work together


  They collaborate to identify where there might be negative or irrational thoughts that will benefit from challenge.
• Challenging negative thoughts relating to negative triad. 


  The aim is to identify negative thoughts about the self, the world, and the future. These thoughts must be challenged by the patient taking an active role in their environment.
• The 'patient as scientist'


  Patients are encouraged to test the reality of their irrational beliefs.

  They might be set homework, e.g. to record when they enjoyed an event or people were nice to them.

  In future session if a patient then says no-one is nice to them or there is no point in going on, the therapist can prove the patient's beliefs incorrect.
• Ellis' rational emotive behavioural therapy (REBT)


  This extends the ABC model to contain D and E.

  • D = to dispute irrational beliefs
  • E = for effect
• Challenging irrational beliefs


  A patient might talk about how unlucky they have been or how unfair life is. An REBT therapist would identify this as utopianism and challenge it.

  • Empirical argument - disputing whether there is evidence to support the irrational belief.
  • Logical argument - disputing whether the negative thought actually follows from the facts.
• Behavioural action


  As individuals become depressed, they tend to increasingly avoid difficult situations and become isolated, which maintains or worsens symptoms.

  The goal of treatment is to work with the individuals to gradually decrease their avoidance and isolation, and increase their engagement in activities that have been shown to improve mood.
• Limitation of CBT - may not work for more severe cases


  In some cases depression can be so severe that patients cannot motivate themselves to take on the hard cognitive work involved in CBT. Where this is the case it is possible to treat patients with medication and then commence CBT when they are more alert. This is a limitation because it means the therapy cannot be used as the sole treatment for all cases of depression.
• Limitation of CBT - there may be an overemphasis on cognition


  CBT may end up reducing the importance of the circumstances in which the patient is living (McCusker). A patient living in poverty or suffering abuse needs to change their circumstances, and any approach that emphasises what is in their mind rather than their environment can prevent this. CBT techniques used inappropriately can demotivate people to change their situation.
• Strength of CBT - it is effective


  There is a large body of evidence to support the effectiveness of CBT for depression, e.g. March compared the effects of CBT, medication and a mix of the two in 327 depressed teens. After 36 weeks 81% of the CBT group, 81% of the medication group, and 86% of the double group were significantly improved. The study showed CBT as effective as drugs. This suggests there is a good cause for making the therapy the first choice of treatment in healthcare systems like the NHS.